Recently proposed property exclusions have created intense debates among agents, adjusters, insurers and insureds. As chaotic weather conditions across the country continue to rise, these exclusions claim to focus on the type of roof damage in an effort to circumvent coverage.  Essentially, what the insurer deems as “cosmetic damage” is excluded from coverage when/if the insurers choose to use this type of endorsement.

That’s where our client, BCD (a family partnership) needed our help. On June 6th, 2018 an intense hailstorm produced wind gusts over 59 miles per hour with massive hail, ultimately destroying windshields, skylights, roofs and other exterior structures on numerous homes and businesses throughout the Dallas area.

The following day, roof leaks began to appear causing water to visibly enter 3 of the 6 commercial properties BCD owns. The businesses impacted by the leaks reached out to their landlord, who promptly filed an insurance claim with Covington Insurance.

After filing the insurance claim with their provider, the insurer sent out an adjuster who reviewed the claim for roof leaks and cited “no damage” to any of the properties. When our clients rebuked the adjuster’s findings, the insurer sent a second adjuster who this time claimed the damage was minimal and fell under the deductible but for only one of the properties. Now befuddled and irritated with their insurance company’s confusing findings, BCD hired their own public adjuster. The insurer responded by sending out an engineer who did recognize the roof damage however he now claimed the damage was merely “cosmetic” in nature.

BCD and their public adjuster recognized what Covington was up to and promptly filed suit. Covington Insurance moved the case to Federal court where both parties were ordered to participate in an early mediation. At mediation, the case settled for more than 200 times the original under-deductible estimate written by Covington. Not only was our client delighted, but the public adjuster who they hired attended mediation and was also relieved to see the insured be fully indemnified. Now our client’s tenants could go back to running their businesses without the constant threat of interior leaks and roof damage disrupting their business operations.

A cosmetic damage exclusion means damage to external surfaces, including walls, roofs, doors, and windows that allegedly only impact the appearance (but not the functional purpose) may not be covered under the policy. These are things insurers consider ornamental or cosmetic and are usually very vaguely defined so that the insurer can tailor the damage as one being “merely cosmetic” to deny the claim.

Just because you have a cosmetic damage exclusion does not mean you are out of luck with your insurance claim. Our expert insurance litigation attorneys know how insurance companies operate and the tactics they employ to delay, deny, or underpay your property insurance claim. Our consultations are free, and you owe us nothing until we win your case. Contact us today.